Quiz Question

In Caldeira 2025 et al., on femoral neck fixation, what complication was more likely with the three-screw construct?

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Correct. The three-screw placement had higher risk of cortical bone wall perforation, especially with narrow femoral necks
Incorrect. The correct answer is Increased risk of cortical perforation.
The three-screw placement had higher risk of cortical bone wall perforation, especially with narrow femoral necks

🔍 Key Findings

Design: In vitro study on cadaveric femurs (n=21) with basilar femoral neck fractures stabilized using 2 vs 3 titanium cannulated screws.

Stiffness: Control > 3-screw > 2-screw (674 > 120 > 90 N/mm).

Yield Load: 3-screw (586 N) > 2-screw (303 N); both < intact femur (2692 N).

Displacement: No difference across groups.

Complication: 3-screw technique more demanding; higher risk of cortical perforation, especially with narrow femoral necks.

Failure Mode: Dislodgement of femoral head + screw shaft bending.

Conclusion: 3 screws = stronger construct than 2 screws. Clinical implications need further study.

Caldeira

Veterinary and Comparative Orthopedics and Traumatology

1

2025

In Vitro Biomechanical Study of Femoral Neck Fracture Fixation with Two or Three Cannulated Screws in Dogs

2025-1-VC-Caldeira-3

Article Title: In Vitro Biomechanical Study of Femoral Neck Fracture Fixation with Two or Three Cannulated Screws in Dogs

Journal: Veterinary and Comparative Orthopedics and Traumatology

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In Banks 2024 et al., on postoperative outcome, what was the median achieved TPA in the full clinical sample?

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Correct. Median postoperative TPA was 5.5°, falling short of the target 5°, especially in small dogs.
Incorrect. The correct answer is 5.5°.
Median postoperative TPA was 5.5°, falling short of the target 5°, especially in small dogs.

🔍 Key Findings Summary

  • Study Design: Retrospective study of 100 radiographs using in silico and clinical data
  • Mean preoperative TPA: 28.6°, higher in small dogs than large (p = .02)
  • Mean planned TPA (in silico): 7.6°, not achieving 5° target (p < .01)
  • Median postoperative TPA: 5.5° overall; higher in small dogs (7°) vs large (4.5°) (p = .06)
  • Postoperative ostectomy position: More distal than recommended; average = 8.6 mm
  • Increased distalizationgreater under-correction of TPA (p = .01)
  • Most accurate correction occurred when ostectomy was ≤7.5 mm from patellar tendon
  • Wedge angle categories (TPA-Pre minus 5–2°) were used based on pre-op TPA

Banks

Veterinary Surgery

1

2024

A mismatch of planning and achieved tibial plateau angle in cranial closing wedge surgery: An in silico and clinical evaluation of 100 cases

2024-1-VS-banks-1

Article Title: A mismatch of planning and achieved tibial plateau angle in cranial closing wedge surgery: An in silico and clinical evaluation of 100 cases

Journal: Veterinary Surgery

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In Eskelinen 2025 et al., on Plate–Pin fixation for MPL, what was the authors’ recommendation regarding the number of screws for TT fixation?

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Correct. In cases with screw breakage, only two screws were used; authors suggest at least three.
Incorrect. The correct answer is Three or more screws.
In cases with screw breakage, only two screws were used; authors suggest at least three.

🔍 Key Findings

  • Plate–Pin TTT fixation resolved MPL in 64/65 stifles with low recurrence (1.5%) and good lameness outcomes postoperatively.
  • Complication rate was 21.5% (14/65 stifles), mostly minor (57%); major issues included pin migration, fracture, or capsular failure.
  • Pin-related issues accounted for 8 of 20 total complications, highlighting implant refinement is needed.
  • No avulsions, TT fixation failures, or luxation recurrence occurred in cases where surgical technique was followed precisely.
  • Surgical deviations increased complication risk 11.3Ă— (p < 0.05), suggesting adherence to protocol is critical.
  • Single-session bilateral MPL surgery had comparable complication rate (3/20) to unilateral surgery (11/45).
  • Screw breakage occurred in 3 cases, suggesting at least 3 screws may be needed for secure TT fixation.
  • Authors suggest temporary pin fixation and later removal may reduce complications, though prospective studies are needed.

Eskelinen

Veterinary and Comparative Orthopaedics and Traumatology

4

2025

Outcome and Complications Following Medial Patellar Luxation Corrective Surgery with Tibial Tuberosity Transposition Using a Locking Plate and a Pin Fixation: 45 Unilateral and 20 Single-Session Bilateral Procedures

2025-4-VCOT-eskelinen-5

Article Title: Outcome and Complications Following Medial Patellar Luxation Corrective Surgery with Tibial Tuberosity Transposition Using a Locking Plate and a Pin Fixation: 45 Unilateral and 20 Single-Session Bilateral Procedures

Journal: Veterinary and Comparative Orthopaedics and Traumatology

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In Espinel Rupérez 2023 et al., on hip toggle stabilization, what was a major cause of technique deviation?

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Correct. This was a common deviation; though implant positions were ideal, 8 major deviations were noted—all in the femoral tunnel.
Incorrect. The correct answer is Femoral tunnel exit outside fovea capitis.
This was a common deviation; though implant positions were ideal, 8 major deviations were noted—all in the femoral tunnel.

🔍 Key Findings

  • Arthroscopic-assisted hip toggle stabilization (AA-HTS) was successfully completed in all 14 feline cadaver joints.
  • Femoral and acetabular tunnel creation was feasible in all cases, though femoral tunnel placement had a higher rate of deviations.
  • Intraoperative complications occurred in 5/14 joints, mostly related to femoral tunnel creation and toggle lodging.
  • Minor articular cartilage injury (<10% total cartilage area) occurred in 10/14 joints, but no injury to neurovascular or intrapelvic structures.
  • Thirteen surgical technique deviations (8 major, 5 minor) were identified in 7 joints, all involving the femoral tunnel.
  • Toggle passage through the femoral tunnel was the most challenging step, being mildly difficult in 6 joints.
  • Postoperative CT and gross dissection confirmed all toggles and buttons were in correct position, without damage to major surrounding structures.
  • No deviations, complications, or cartilage injuries occurred in the last 4 joints, suggesting a learning curve effect.

Espinel Rupérez

Veterinary Surgery

6

2023

Arthroscopic-assisted hip toggle stabilization in cats: An ex vivo feasibility study

2023-6-VS-espinel-5-cdb86

Article Title: Arthroscopic-assisted hip toggle stabilization in cats: An ex vivo feasibility study

Journal: Veterinary Surgery

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In Sullivan 2025 et al., on TTT stabilization methods, what theoretical advantage does the spacer pin technique offer?

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Correct. Avoiding tuberosity pins may reduce risk of soft tissue irritation or fracture.
Incorrect. The correct answer is Avoids placing pins through tuberosity.
Avoiding tuberosity pins may reduce risk of soft tissue irritation or fracture.

🔍 Key Findings

  • Spacer pin fixation showed no difference in failure force or stiffness compared to tension band wire (TBW) or 2-pin techniques.
  • All constructs failed under loads >1000 N, exceeding estimated peak quadriceps force in dogs during walking (~240 N).
  • Patellar ligament failure was the most common mode of failure across all groups (5–8 samples per group).
  • Distal tibial crest fractures were seen only in 2-pin and spacer pin groups, not in TBW group, suggesting TBW may protect against crest failure.
  • No failures occurred at pin tracts, possibly due to pin placement within patellar ligament footprint.
  • Spacer pin technique avoids placing pins through the tuberosity, potentially reducing risks of soft tissue complications like tendinopathy or irritation.
  • Use of partial osteotomy with robust distal crest may substitute for TBW without compromising initial mechanical strength.
  • Further in vivo or cyclic loading studies are required, as this cadaveric study tested only acute tensile failure.

Sullivan

Veterinary and Comparative Orthopaedics and Traumatology

3

2025

Biomechanical Comparison of Spacer Pin Fixation to Two Established Methods of Tibial Tuberosity Transposition Stabilization in Dogs

2025-3-VCOT-sullivan-4

Article Title: Biomechanical Comparison of Spacer Pin Fixation to Two Established Methods of Tibial Tuberosity Transposition Stabilization in Dogs

Journal: Veterinary and Comparative Orthopaedics and Traumatology

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In Banks 2024 et al., what ostectomy position was associated with the most accurate postoperative TPA?

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Correct. Accuracy in achieving target TPA was best when the ostectomy was placed ≤7.5 mm from patellar tendon origin.
Incorrect. The correct answer is ≤7.5 mm from patellar tendon origin.
Accuracy in achieving target TPA was best when the ostectomy was placed ≤7.5 mm from patellar tendon origin.

🔍 Key Findings Summary

  • Study Design: Retrospective study of 100 radiographs using in silico and clinical data
  • Mean preoperative TPA: 28.6°, higher in small dogs than large (p = .02)
  • Mean planned TPA (in silico): 7.6°, not achieving 5° target (p < .01)
  • Median postoperative TPA: 5.5° overall; higher in small dogs (7°) vs large (4.5°) (p = .06)
  • Postoperative ostectomy position: More distal than recommended; average = 8.6 mm
  • Increased distalizationgreater under-correction of TPA (p = .01)
  • Most accurate correction occurred when ostectomy was ≤7.5 mm from patellar tendon
  • Wedge angle categories (TPA-Pre minus 5–2°) were used based on pre-op TPA

Banks

Veterinary Surgery

1

2024

A mismatch of planning and achieved tibial plateau angle in cranial closing wedge surgery: An in silico and clinical evaluation of 100 cases

2024-1-VS-banks-5

Article Title: A mismatch of planning and achieved tibial plateau angle in cranial closing wedge surgery: An in silico and clinical evaluation of 100 cases

Journal: Veterinary Surgery

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In Moreira 2024 et al., which CCWO technique resulted in the lowest mean prediction error for postoperative TPA?

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Correct. The Slocum method, based on tibial plateau and cranial cortex alignment, had the lowest mean TPA error (–0.7°).
Incorrect. The correct answer is Slocum-type wedge.
The Slocum method, based on tibial plateau and cranial cortex alignment, had the lowest mean TPA error (–0.7°).

🔍 Key Findings Summary

  • Study Type: In silico 3D modeling of canine tibiae (n = 20 limbs)
  • Four techniques evaluated:
    1. Proximal-centered wedge
    2. Middle-centered wedge
    3. Distal-centered wedge
    4. Slocum-type wedge (based on tibial plateau and cranial cortex)
  • Target TPA: 5°
  • Most accurate: Slocum technique had the smallest mean prediction error (mean = –0.7°, SD = 0.5°)
  • Least accurate: Proximal-centered wedge (mean error = –2.9°, SD = 1.2°)
  • Error variation: Prediction error increased with greater initial TPA; high correlation (R² = 0.74)
  • Conclusion: Planning based on tibial plateau and cranial cortex (Slocum method) yields better TPA predictability

Moreira

Veterinary Surgery

1

2024

Predicting tibial plateau angles following four different types of cranial closing wedge osteotomy using patient-specific 3-dimensional computer models

2024-1-VS-moreira-1

Article Title: Predicting tibial plateau angles following four different types of cranial closing wedge osteotomy using patient-specific 3-dimensional computer models

Journal: Veterinary Surgery

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In de Moya 2023 et al., on FGPP of femoral capital physeal/neck fractures, what was the median surgical time for FGPP procedures?

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Correct. Median surgery time was 60 minutes (range 45–75 min).
Incorrect. The correct answer is 60 minutes.
Median surgery time was 60 minutes (range 45–75 min).

🔍 Key Findings

  • 11 dogs, 13 fractures (mostly Salter-Harris type I) were repaired with FGPP using Kirschner wires.
  • 10/13 fractures achieved satisfactory healing with good limb function at ~43 days median follow-up.
  • Major complications occurred in 5 dogs: intra-articular pin placement, implant migration (2), implant failure with nonunion, and malunion.
  • 2 dogs presenting >15 days post-injury with radiographic remodeling were poor candidates → higher risk of nonunion/malunion.
  • Preoperative displacement was mostly mild (10/13 fractures); these had better outcomes than chronic or severely displaced cases.
  • Median surgical time: 60 minutes (range 45–75), all performed percutaneously without conversion to open.
  • Elective pin removal was performed in 5 cases; migration occurred with both short and long cut wires.
  • Femoral neck resorption (“apple-coring”) was rare (2/10 healed cases) and thought to be less frequent than after ORIF due to reduced vascular disruption.

de Moya

Veterinary Surgery

7

2023

Closed reduction and fluoroscopic-guided percutaneous pinning of femoral capital physeal or neck fractures: Thirteen fractures in 11 dogs

2023-7-VS-demoya-5

Article Title: Closed reduction and fluoroscopic-guided percutaneous pinning of femoral capital physeal or neck fractures: Thirteen fractures in 11 dogs

Journal: Veterinary Surgery

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In de Moya 2023 et al., on FGPP of femoral capital physeal/neck fractures, which major complication was reported following FGPP?

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Correct. One dog developed an intra-articular pin, requiring revision and ultimately FHO.
Incorrect. The correct answer is Intra-articular pin placement.
One dog developed an intra-articular pin, requiring revision and ultimately FHO.

🔍 Key Findings

  • 11 dogs, 13 fractures (mostly Salter-Harris type I) were repaired with FGPP using Kirschner wires.
  • 10/13 fractures achieved satisfactory healing with good limb function at ~43 days median follow-up.
  • Major complications occurred in 5 dogs: intra-articular pin placement, implant migration (2), implant failure with nonunion, and malunion.
  • 2 dogs presenting >15 days post-injury with radiographic remodeling were poor candidates → higher risk of nonunion/malunion.
  • Preoperative displacement was mostly mild (10/13 fractures); these had better outcomes than chronic or severely displaced cases.
  • Median surgical time: 60 minutes (range 45–75), all performed percutaneously without conversion to open.
  • Elective pin removal was performed in 5 cases; migration occurred with both short and long cut wires.
  • Femoral neck resorption (“apple-coring”) was rare (2/10 healed cases) and thought to be less frequent than after ORIF due to reduced vascular disruption.

de Moya

Veterinary Surgery

7

2023

Closed reduction and fluoroscopic-guided percutaneous pinning of femoral capital physeal or neck fractures: Thirteen fractures in 11 dogs

2023-7-VS-demoya-4

Article Title: Closed reduction and fluoroscopic-guided percutaneous pinning of femoral capital physeal or neck fractures: Thirteen fractures in 11 dogs

Journal: Veterinary Surgery

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In Mazdarani 2025 et al., on simulated muscle loading, what was the clinical significance of using hip mobility in limb press models?

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Correct. Hip mobility improved the physiologic realism of simulated quadriceps forces.
Incorrect. The correct answer is It allowed force ratios closer to in vivo values.
Hip mobility improved the physiologic realism of simulated quadriceps forces.

🔍 Key Findings

  • Simulated quadriceps and gastrocnemius forces increased proportionally with axial load in all three femoral fixation models.
  • Model 2 (rigid fixation) resulted in subphysiologic quadriceps forces and abnormally high gastrocnemius forces, reducing model fidelity.
  • Models 1 and 3 (with hip mobility) produced more physiologic quadriceps and force ratios, especially under 30–40% bodyweight loads.
  • Force ratios were significantly lower in rigid fixation (Model 2) compared to hip-mobile models (p = .007), suggesting model design affects simulated muscle coordination.
  • Joint angles (stifle and hock) remained within acceptable limits, though slight flexion occurred with increasing load.
  • Relative foot position differed by ~3.9 mm between models 2 and 3, with model 2 showing a more caudal position.
  • Model 3 preserved benefits of hip mobility while allowing radiographic documentation, making it a preferred setup for future studies.
  • The study suggests that models used in feline stifle stabilization research may underestimate physiologic forces, especially with rigid fixation designs.

Mazdarani

Veterinary Surgery

5

2025

Proximal femoral fixation method and axial load affect simulated muscle forces in an ex vivo feline limb press

2025-5-VS-mazdarani-5

Article Title: Proximal femoral fixation method and axial load affect simulated muscle forces in an ex vivo feline limb press

Journal: Veterinary Surgery

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Quiz Results

Topic: Femoral Fixation
70%

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